Publisher Health

The NewsOne-year-olds exposed to more than four hours of screen time a day experienced developmental delays in communication and problem-solving skills at ages 2 and 4, according to a study published today in The Journal of the American Medical Association Pediatrics.The research also found that 1-year-olds who were exposed to more screen time than their peers showed delays at age 2 in the development of fine motor and personal and social skills. But these delays appeared to dissipate by age 4.The study did not find that the screen time caused the developmental delays but, rather, found an association between babies who were exposed to more screen time and delays in their development. That pattern could well be explained by the value of face-to-face time for young children, experts said.The research also found that 1-year-olds exposed to more screen time than their peers showed delays at age 2 in the development of fine motor and personal and social skills.Kike Calvo/AlamyWhy It MattersDavid J. Lewkowicz, a developmental psychologist at the Yale Child Study Center, said that face-to-face interaction between parent and child is crucial in giving babies a rich set of information, including about how facial expressions, words, tone of voice and physical feedback all combine to convey language and meaning.“It doesn’t happen when you’re watching the screen,” he said, adding that he was not surprised by the research results.The findings, conducted by scholars in Japan, were drawn from questionnaires about development and screen time, which were given to parents of nearly 8,000 young children. In general, babies exposed to higher levels of screen time were found to be the children of first-time mothers who were younger, and with lower incomes and household education levels, and those suffering postpartum depression. (Only 4 percent of babies were reported to be exposed to screens for four or more hours a day, while 18 percent had two to less than four hours of screen time a day and a majority had less than two hours.)The study noted a “dose-response association” between screen time and developmental delays: The more screen time babies were given, the more likely they were to show developmental delays.What’s NextThe study’s authors noted that the research did not distinguish between screen time that was intended to be educational and screen time more focused on entertainment. Future studies, the researchers added, should explore that angle.Dr. Lewkowicz said that parents regularly asked him how much screen time was the right amount. His answer: “Talk to your child as much as you can, face-to-face as much as you can,” he said.To ask parents to withhold all screen time from their babies was impractical, he said: “No parent would listen to that. It just has to be in moderation. With a heavy dose of real-life social interaction.”

Social risk factors such as financial instability and housing insecurity are increasingly recognized as influencing health. But unlike diagnosis codes, prescription information, lab or other test reports, social risk factors do not adhere to standardized, controlled terminology in a patient’s electronic medical record, making this information difficult to extract from the clinical notes where they typically are found.
A new study has found that a natural language processing (NLP) system developed by Regenstrief Institute and Indiana University Richard M. Fairbanks School of Public Health informaticians showed excellent performance when ported to a new health system and tested on more than six million clinical notes of patients seen in Florida. Performance was evaluated for generalizability and portability, defined as ease and accuracy when deploying the software in a new environment and of updating its use to meet the needs of new data.
“Social factors have a great impact on our health. It’s not just the medical care that we receive, but it’s also the places where we live, the places where we work and our access to food and transportation and other resources that have a major influence on our health,” said Chris Harle, PhD, the Regenstrief and IU Fairbanks School faculty member who is senior author on the study. “It’s important for the clinicians and health systems providing medical care to know about people’s social risk factors so when prescribing medications, ordering tests or planning to perform a procedure, they can better treat the whole person — perhaps with lower cost drugs or alternative sources for tests — and can also link them to services that help address their needs for a safe place to live and healthy food to eat.”
In this study, the researchers’ NLP rule-based model searched through text that physicians or other clinicians had written in the clinical notes of patients’ electronic health records, looking for key words or phrases that were likely to indicate difficulty with housing (for example: lack of permanent address) or financial needs (for example: inability to afford follow-up care) of patients at a healthcare system in a new and quite different geographic area. In spite of challenges (for example: name of a homeless shelter without indication of the facility’s function or regional variation or local nuances in language), the research scientists verified that the NLP models, with relatively simple modifications, could deliver highly accurate performance as compared to the gold standard of human review.
“Is a patient diagnosed with diabetes? It’s relatively easy to find that information in an electronic health record because the same words and codes are more likely to be used in health systems in central Indiana as are used in Florida or elsewhere in the U.S. But social risk factors don’t have nearly as established and widely used words, phrases or codes to identify them. Therefore, it’s harder to search through and determine a patient has a financial need than it is to say a patient has diabetes,” said Dr. Harle. “Our work is important for patients because ultimately their health is related to a variety of factors in their life, including social factors. For example, are clinicians incorporating in their decision making a patient’s ability to recover from a surgery as it’s going to be different if they have stable housing versus unstable housing?
“The more that we can disseminate and adapt natural language processing and other artificial intelligence methods that fully describe a patient to give clinicians a full 360 understanding of patients’ needs, the better. If we can extract social information more efficiently, it’s less costly. Then we can start to take what we’d call a population health perspective. So, if a health system can efficiently identify the patients who have housing instability — the population of patients who have this need — then the healthcare system may be able to employ a more proactive population-based intervention to serve that whole group of people, connecting them, for example, to the housing services in the community or financial resources that might be available.”
Dr. Harle, an information scientist and health services researcher who focuses on the design, adoption, use and value of health information systems, notes that this study was a team effort across multiple institutions of professionals who work in the clinical arena (including individuals who study how patients access and use care), public health, population health and healthcare administration as well as technically knowledgeable and skilled systems specialists. “Bringing people together who have that diversity of understanding leads to pragmatically useful studies like this one,” he said.

Various medical circumstances, including heart attacks and extreme cases of COVID-19, necessitate the use of anticoagulants, medicines that prevent blood clots. But the most commonly used, heparin, can induce potentially fatal side effects by making the blood clots worse rather than better. This only happens in a minority of patients so effective treatments are not commonly explored. For the first time, researchers, including those from the University of Tokyo, have proposed a side effect-free anticoagulating treatment that has so far proved effective in test mice and could be ready for human trials in just a few years.
The COVID-19 pandemic brought much woe to people around the world. And at the time of writing, though much of the world seems to have moved on, the effects of the pandemic continue to linger. One aspect of some extreme cases of COVID-19 that has not been widely reported is the complication brought on when the anticoagulant medicine heparin is used in an attempt to reduce blood clots in patients. A small number — up to 3% of recipients — suffer the side effect heparin-induced thrombocytopenia (HIT), a potentially fatal and rapid clotting of the blood, the opposite of the intended effect. Other medical issues, such as heart attacks, kidney dialysis, and even some surgeries, can also require anticoagulants.
Heparin was the first anticoagulant and is used widely — it’s considered incredibly important by the World Health Organization. But, because of the low number of HIT sufferers and thus lack of interest from the pharmaceutical industry, this issue is underexplored, despite its severity and increase due to COVID-19. It can be especially problematic in pregnant women as they cannot take existing treatments due to those potentially adversely affecting the fetus.
“The best treatment for HIT is an infusion of what are called thrombin inhibitors, but current drugs can lead to severe bleeding and there is no antidote to avoid this,” said Associate Professor Keitaro Yoshimoto from the Department of Life Sciences at the University of Tokyo. “Ideally, we could avoid HIT altogether. But at present, that is not possible, so we need a new low-risk thrombin inhibitor to replace current drugs. My team and I have created such an anticoagulant and have demonstrated it in mice and also in human blood plasma.”
The team devised a next-generation thrombin inhibitor consisting of DNA molecules which includes a novel mechanism to prevent the severe bleeding. The key molecule in the drug is called a bispecific aptamer and its special feature is being able to bind to multiple things simultaneously. Another useful feature is short DNA sections which act as an antidote to the undesirable clotting side effect during HIT. This DNA-based drug essentially enables more complex behaviors than drugs based on simpler, more traditional chemistry. From their studies in mice, the team has shown the treatment is around 10 times as effective as the current best treatments for HIT. An additional benefit to pregnant women is that the nucleic acid-based drug and accompanying antidote do not cross the placenta to the fetus, as the DNA molecules in the drug are too large to cross the barrier presented by the placenta.
This research came about as Yoshimoto has a history in biochemistry and the science of molecular separation, specializing in a method called MACE®-SELEX for the selection of aptamers, short sections of DNA useful for medicine. He teamed up with Assistant Professor Asuka Sakata of Nara Medical University in Japan who specializes in thrombosis biology, and together with their team, they embarked on using Yoshimoto’s ideas to solve medical issues raised in Sakata’s research.
“We hope to proceed with human trials soon,” said Yoshimoto. “It will take up to two years for preclinical studies and five years to complete clinical trials in humans. Though the number of HIT sufferers is small, it’s such a severe condition I feel it’s important we tackle it quickly.”

Anti-estrogenic therapies can suppress the growth of cancer that does not express estrogen receptors; when combined with immune checkpoint inhibitor therapies, they halt tumor progression in mice models.
Estrogen, a group of female hormones, is known to be involved in cancer progression, especially breast cancer. About 75 % of breast cancers are estrogen-sensitive: they express the hormone receptor estrogen receptor α (ERα), and estrogen promotes tumor growth. Surprisingly, estrogen has been observed to promote tumor growth in ERα-negative cancers, such as triple-negative breast cancer (TNBC), for reasons that are not fully understood.
A team of researchers from the Institute for Genetic Medicine (IGM) at Hokkaido University has uncovered how estrogen affects the tumor microenvironment and promotes tumor growth in ERα-negative cancers. Their findings were published in the British Journal of Cancer.
“Generally speaking, estrogen directly affects cancer cells to promote cell survival and proliferation, and this has been considered to hold true only for estrogen-sensitive cancers,” explains Nabeel Kajihara, lead author of the paper. “Estrogen is also documented to play other roles in the tumor microenvironment, effectively suppressing the immune response and protecting tumors.”
The researchers analyzed patient data from The Cancer Genome Atlas (TCGA) and conducted experiments in cell cultures and mice models to understand what was happening.
From the TCGA data, they observed that, in TNBC, estrogen suppresses the induction of cytotoxic T cells, which typically recognize and destroy cancer cells. They confirmed this observation in mice TNBC and colon cancer models, which do not have estrogen sensitivity; they then went one step further and studied the effects of anti-estrogenic therapy on these cancers in mice models. Therapy with fulvestrant, the most effective estrogen signal blocker currently approved for clinical use, suppressed the growth of tumor cells. Tumor growth was also suppressed by two other approved anti-estrogenic drugs, tamoxifen and anastrozole, confirming that estrogen signal-blocking was responsible.
Estrogen signal blockers modulate immune response to increase production of cytotoxic T cells, specifically by preventing the activity of estrogen. The team also showed that therapy combining estrogen signal blockers with a class of drugs called immune checkpoint inhibitors (ICIs) drastically suppresses tumor progression in mice models. Most notably, the combination of fulvestrant (anti-estrogenic) and anti-CTLA-4 (ICI) resulted in the complete suppression of TNBC tumor progression.
“We have demonstrated that anti-estrogenic therapies can potentially maximize therapeutic efficacy of cancer immunotherapy regardless of tumor cells’ ERα expression,” concludes Professor Seino. “However, this is only the first step; future clinical research is required to develop cancer therapies that utilize this approach.”

In recent years, pneumatic artificial muscles (PAMs) have emerged as promising actuators for simulating human-like movements, with prominent applications in various industries including robotics, rehabilitation, and prosthetics. PAMs are usually composed of rubber and covered with braided yarn and can mimic the mechanics of human muscles. They can stiffen and contract on being supplied with pressurized air and soften and lengthen upon releasing the air. However, PAM is a nonlinear system and experiences huge latency, making it important to have control systems that can regulate their performance.
While determining a nonlinear mathematical model for PAM is challenging, researchers in the past have proposed many control methods to solve the problems associated with PAM. However, while these traditional control methods exhibit decent performance, they are not able to deal with PAM’s nonlinearity and hysteresis. Moreover, while learning control algorithms have been theoretically effective in improving PAM-based system’s performance, their implementation is practice is quite difficult.
To overcome these limitations and address this open problem, a group of researchers led by Associate Professor Ngoc-Tam BUI of the Innovative Global Program, College of Engineering, Shibaura Institute of Technology in Japan, along with Dr. Quy-Thinh Dao of Hanoi University of Science and Technology, has proposed a novel solution. In their study published in the journal Scientific Reports on 22 May 2023, they propose a control approach called “adaptive fuzzy sliding mode controller (or AFSMC)” that uses fuzzy logic (a type of computational thinking) for estimating control parameters of PAM-based systems.
“The proposed innovative control strategy leverages the Takagi-Sugeno fuzzy algorithm to estimate the disturbance component and automatically update the output variable values, demonstrating enhanced tracking accuracy and adaptability compared to traditional sliding mode control methods,” explains Associate Professor BUI.
The researchers first developed a sliding mode controller with a control signal that incorporates a special variable to estimate the disturbances and improve the control performance. Next, they designed an adaptive fuzzy algorithm, wherein parameter vectors of the component rules are automatically updated by an adaptive law, to compute the disturbance variable. The stability of the developed ASFMC algorithm was then analyzed using the Lyapunov stability condition (used to study the stability of a nonlinear system). Furthermore, the researchers conducted a series of experiments to assess the performance of their controller by comparing it with traditional sliding mode control methods.
Remarkably, the AFSMC approach exhibited improved tracking accuracy, with a root mean square error value of 2.68° at a frequency of 0.5 Hz under load, while the sliding mode controller approach displayed a higher value of 4.21°. Moreover, it showed exceptional adaptability to abrupt external disturbances. Explaining these results further, Associate Professor BUI says, “In a comparative evaluation against the well-known commercial rehabilitation system, LOKOMAT, the AFSMC controller delivered similar performance. It also exhibited superior adaptability to sudden load changes, swiftly returning to the desired trajectory by manipulating its control output.”
These findings thus point to the potential of the novel AFSMC approach for integration into robotic rehabilitation devices, assistive devices, and physical therapy equipment for precise and personalized therapy. Moreover, this approach can aid in the design and development of advanced prosthetic limbs for enhanced functionality and rehabilitation outcomes.
Talking about the long-term implications of this study, Associate Professor BUI says: “With the outcomes of this research, the emergence of a commercial rehabilitation system actuated by PAM can be anticipated within the next 5 to 10 years. This innovative system will provide significant benefits to patients, including those with spinal cord injuries and stroke and others requiring rehabilitation.”
While this research has laid the groundwork for advancing trajectory tracking control in PAM systems, we hope that it ignites further exploration and development in the field of rehabilitation technology.

As a single organ, our skin is able to perform a broad repertoire of vital functions. Dermatology experts call for a reference guide to single-cell composition of normal human skin, which is still lacking. A grassroots movement to establish a Human Skin Cell Atlas is taking shape, as reported in a review in the Journal of Investigative Dermatology, published by Elsevier. A global team of experts has outlined a roadmap as a first step towards creating a comprehensive and inclusive reference work on this important topic.
Our skin performs vital functions, such as protecting us from external threats (pathogens, UV rays), regulating our body’s temperature, giving us our sense of touch, and enabling us to express ourselves via cranial and facial hair. Skin is also anatomically diverse across the body, a feature biologists call “regional specificity.” For instance, hairless skin on our palms with complex fingerprints is dramatically distinct from skin with hair on our scalp. To perform its numerous functions and to maintain prominent regional specificity, skin consists of several distinct cell types, which in turn, each contain numerous cell states.
Using single-cell RNA-sequencing (scRNA-seq) technology, researchers can study gene expression signatures of many individual cells in tissues and then bioinformatically evaluate how they work together to perform tissue functions.
Co-lead author Maksim Plikus, PhD, from the Department of Developmental and Cell Biology at the University of California, Irvine, explains, “Many co-authors on this review were early adopters of single-cell technologies. This technology requires in-depth understanding of bioinformatic approaches and detailed knowledge of conserved gene expression features of distinct skin cell types. As such, the research field has now reached a critical inflection point when a reference guide to single-cell composition of normal human skin is acutely needed.”
Responding to this critical need, the Human Cell Atlas is an international grassroots effort to generate a comprehensive single-cell reference of every human organ.
Co-lead author Maria Kasper, PhD, from the Department of Cell and Molecular Biology at the Karolinska Institute, adds, “Because we are passionate about human skin biology and versed in single-cell methods, we put together this review as a guide for achieving the goal to generate the Human Skin Cell Atlas (HSCA). This review, a roadmap of a kind, will be the first step, followed by a joint effort to generate the actual atlas.”
The initial atlas will be based on sequenced cells collected from healthy human skin. The authors envision that this atlas would then be used as the basis to uncover both conserved and varying human skin cell populations as well as molecular differences that arise upon skin diseases. Once complete and up and running as an open-source online resource, it will be possible to utilize a consensus atlas for semi-automated mapping of patient-specific changes in any future scRNA-seq data. In addition, in the future, the HSCA reference could be used to support personalized medicine, such as single-cell-based personalized diagnostics of skin diseases.
The review is a collection of knowledge from skin experts ranging from basic scientists to clinicians and from trainees to seasoned principal investigators. It outlines key considerations for the atlas in order to comprehensively represent skin cells across five scales: spatial, temporal, gender, ancestral origin, and wound response scales.
As part of the roadmap to develop the HSCA, the authors also emphasize the importance of global representation, reflecting skin of the broader human population, rather than that of only selected human groups that are typically over-represented in biomedical research. They further highlight that for the HSCA to be balanced, scientists need to comprehensively consider unintentional biases that can be easily introduced during single-cell data collection and generation. Such biases include under-representation of skin from minority groups, difficult-to-sample body sites, and technical consistency in generating scRNA-seq data among different laboratories.
Finally, a standardized metadata template is proposed to collect detailed information when generating new scRNA-seq datasets.

Zinc-air batteries have emerged as a better alternative to lithium in a recent Edith Cowan University (ECU) study into the advancement of sustainable battery systems.
ECU’s Dr Muhammad Rizwan Azhar led the project which discovered lithium-ion batteries, although a popular choice for electric vehicles around the world, face limitations related to cost, finite resources, and safety concerns.
“Rechargeable zinc-air batteries (ZABs) are becoming more appealing because of their low cost, environmental friendliness, high theoretical energy density, and inherent safety,” Dr Muhammad Rizwan Azhar said.
“With the emergence of next-generation long-range vehicles and electric aircraft in the market, there is an increasing need for safer, more cost-effective, and high-performance battery systems that can surpass the capabilities of lithium-ion batteries.”
Zinc-air: An explainer
A zinc-air battery consists of a zinc negative electrode and an air positive electrode.
The major disadvantage of these has been the limited power output, due to poor performance of air electrodes and short lifespan — until now.

Genetic remnants of viruses that are naturally present in the human genome could affect the development of neurodegenerative diseases. Researchers at DZNE come to this conclusion on the basis of studies on cell cultures. They report on this in the journal Nature Communications. In their view, such “endogenous retroviruses” could contribute to the spread of aberrant protein aggregates — hallmarks of certain dementias — in the brain. Thus, these viral relicts would be potential targets for therapies.
It has been suspected for some time that viral infections contribute to the genesis and development of neurodegenerative diseases. Laboratory studies by DZNE scientists now suggest a mechanism that, although related to viruses, does not require infection by external pathogens. According to this study, the culprits would be “endogenous retroviruses” that are naturally present in the human genome. “During evolution, genes from numerous viruses have accumulated in our DNA. Most of these gene sequences are mutated and normally muted,” explained Ina Vorberg, research group leader at DZNE and a professor at the University of Bonn. “However, there is evidence that endogenous retroviruses are activated under certain conditions and contribute to cancer and neurodegenerative diseases. Indeed, proteins or other gene products derived from such retroviruses are found in the blood or tissue of patients.”
Experiments with Tau Aggregates
Vorberg followed this trail together with colleagues from Bonn and Munich. Using cell cultures, the researchers simulated the situation in which human cells produce certain proteins from the envelope of endogenous retroviruses. Specifically, this involved HERV-W and HERV K — both viruses are present in the human genome but are usually dormant. However, studies indicate that HERV-W is activated in multiple sclerosis and HERV-K in the neurological disease “amyotrophic lateral sclerosis” (ALS) and in frontotemporal dementia (FTD). Now, Vorberg’s team found that the viral proteins facilitate the transport of so-called tau aggregates from cell to cell. “Tau aggregates” are tiny protein clumps that occur in the brains of people affected by certain neurodegenerative diseases — these include Alzheimer’s disease and FTD. “Certainly, conditions in the brain are much more complex than our cellular model system can replicate them. Nevertheless, our experiments show that endogenous retroviruses can influence the spread of tau aggregates between cells,” Vorberg said. “Endogenous retroviruses would thus not be triggers of neurodegeneration, but could fuel the disease process once it is already underway.”
Viral Transport Mediators
The current research and earlier studies by Vorberg’s team suggest that viral proteins serve as transport mediators for tau aggregates because they insert into the cell membrane and into the membrane of so-called extracellular vesicles: These are small fat bubbles that are naturally secreted by cells. “For the transport of tau aggregates from cell to cell, we see two pathways in particular. Transfer between cells that are in direct contact, and transport within vesicles that act as cargo capsules, so to speak, and pass from one cell to another to eventually merge with it,” Vorberg explained. “In both scenarios, membranes have to fuse. Proteins from the envelope of viruses can promote this process. That’s because many viruses are adapted to fuse with host cells. This happens by means of special proteins that viruses carry on their surfaces. If precisely these proteins are incorporated into the cell membrane and the membrane of extracellular vesicles, it is understandable that the tau aggregates then spread more easily.”
Starting Points for Therapy
In the course of the natural aging process, the regulation of genes can change — originally “dormant” endogenous retroviruses could be “awakened” as a result. Indeed, the symptoms of most neurodegenerative diseases do not manifest until older age. This raises two conceivable approaches to therapy. “On the one hand, one could try to specifically suppress gene expression, that is, to inactivate the endogenous retroviruses again. That would get to the root of the problem,” Vorberg said. “But you could also start elsewhere and try to neutralize the viral proteins — for example, with antibodies.”
Searching for Antibodies
In the opinion of the researchers, it is likely that dementia patients with tau aggregates carry increased amounts of such antibodies. If it were possible to isolate these and reproduce them using biotechnological methods, it might be possible to develop a passive vaccine. Thus, in collaboration with DZNE colleagues in Berlin and Bonn, Vorberg’s team aims to specifically search for such antibodies in patients. In addition, the scientists are considering antiviral drugs. In cell culture, they have already found that such agents can actually stop the spread of protein aggregates. “This is another approach we intend to pursue,” said Vorberg.

People who have recovered from a major depressive episode, when compared with individuals who have never experienced one, tend to spend more time processing negative information and less time processing positive information, putting them at risk for a relapse, according to research published by the American Psychological Association.
“Our findings suggest that people who have a history of depression spend more time processing negative information, such as sad faces, than positive information, such as happy faces, and that this difference is greater compared to healthy people with no history,” said lead author Alainna Wen, PhD, a postdoctoral scholar at the Anxiety and Depression Research Center at the University of California, Los Angeles. “Because more negative thinking and mood and less positive thinking and mood are characteristic of depression, this could mean that these individuals are at a greater risk for having another depressive episode.”
The research was published in the Journal of Psychopathology and Clinical Science.
Major depression is one of the most common mental disorders in the United States. In 2020, approximately 21 million U.S. adults reported at least one incidence of major depression (8.4% of the U.S. population), according to the National Institute of Mental Health. Defined as a period of at least two weeks of a depressed mood or loss of interest or pleasure in daily activities, major depression can interfere with or limit a person’s ability to carry out major life activities.
Despite well-established treatments for depression, relapse rates for major depressive disorder remain high, according to Wen. More than 50% of individuals with a first-time major depressive episode will experience subsequent episodes, often relapsing within two years of recovery. Thus, more insight is needed into the risk factors involved in major depressive disorder to improve treatment and prevent relapse.
For this paper, researchers conducted a meta-analysis of 44 studies involving 2081 participants with a history of major depressive disorder and 2285 healthy controls. All studies examined participants’ response times to negative, positive or neutral stimuli. In some cases, participants were shown either a happy, sad or neutral human face and asked to push a different button for each. In others, participants reacted to positive, negative or neutral words.
Healthy participants as a group responded more quickly to emotional and non-emotional stimuli than participants with a history of depression, regardless of whether those stimuli were positive, neutral or negative. But participants who previously had major depressive disorder spent more time processing negative emotional stimuli over positive stimuli compared with controls. While healthy controls showed a significant difference in how much time they spent processing positive vs. negative emotional stimuli compared with those in remission from major depression, that distinction did not appear when comparing time spent processing negative vs. neutral or positive vs. neutral stimuli.
Overall, the findings suggest that individuals with recurrent major depressive disorder not only are less able to control the information they process than healthy individuals, they also display a greater bias for focusing on negative over positive or neutral information, according to Wen.
“The current findings have implications for the treatment of depression,” said Wen. “Focusing on reducing the processing of negative information alone may not be sufficient to prevent depression relapse. Instead, patients may also benefit from strategies to increase the processing of positive information.”

Published30 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Cheshire PoliceBy Judith Moritz & Daniel O’Donoghue & Lauren Hirst & Monica RimmerBBC NewsThe mother of a baby boy killed by nurse Lucy Letby says she is “horrified that someone so evil exists”.The 33-year-old was found guilty of murdering seven babies and attempting to kill six others at the Countess of Chester Hospital between 2015 and 2016.Her conviction makes her the UK’s most prolific child serial killer in modern British history.Letby has refused to appear in the dock for her sentencing.The public gallery is full of parents of the babies – some cried quietly as the victim impact statements were read. Some of the jury members also appeared upset as they heard the statements.The mother of Baby C told the court that knowing his murderer was watching over them was like “something out of a horror story”.Image source, Cheshire Police”I will always remember the overwhelming wave of emotion I felt when I first held [Baby C],” she said. “It was like nothing I’d ever experienced before. My tiny feisty boy. My first born. My son.”The trauma of that night will live with us forever.”Knowing his murderer was watching us was like something out of a horror story.”The parents of Baby A and B said “what should have been the happiest time of our lives became our worst nightmare”.They said perhaps Letby imagined she would be remembered for her crimes but they told the court: “My family will never think of you again – from this day, you are nothing.”‘Evil disguised’The mother of Baby D said Letby’s “wicked sense of entitlement and abuse of her role as a trusted nurse” was a “scandal”.”You failed God and the plans he had for [Baby D]. You even called it fate,” she said.”You were clearly disconnected with God.”This video can not be playedTo play this video you need to enable JavaScript in your browser.The mother of Baby E and F described Letby as a “coward” for failing to attend the sentencing hearing, adding: “Our world was shattered when we encountered evil disguised as a caring nurse.””Even in these final days of the trial she has tried to control things,” she said.”The disrespect she has shown the families and the court show what type of person she is.”We have attended court day in and day out, yet she decides she has had enough, and stays in her cell, just one final act of wickedness from a coward.”Baby serial killer Lucy LetbyFollow live: Families speak as Letby refuses to face courtThe text messages Letby sent as she killed babiesWho is baby serial killer Lucy Letby? Doctors’ warnings ignored as Letby killed more babiesHow could the NHS stop a future killer within?The father of Baby G said she had been left severely disabled as a result of Letby’s attacks.”What if she outlives us? Who will care for her then?”Her condition affects every aspect of our lives,” he said.In a statement, read out on behalf of Baby I’s mother, she said: “When they told us they were arresting someone for [Baby I’s] murder, I remember my whole body shaking.”We were both absolutely broken that some one could do something so evil to our precious little girl and this has had a massive effect on our family even until this day.”We dug for years trying to get answers for what had happened and over the years we have been in some very dark places mentally.”Image source, Cheshire PoliceThe father of Baby L and Baby M said: “Initially doctors told us that the whole events that took place in 2016 surrounding my children was normal for premature babies and we believed what the doctors were telling us at the time. “Little did we know that a year or so after their birth the police would come knocking on the door and break the news that this could be an attempted murder case.”He said he had been prescribed anti-depressants.”Even though they have helped they can never take away the feelings I have as a parent knowing now what had truly happened at the Countess of Chester in 2016 and it doesn’t make it any easier to cope with over time,” he said. In a statement read to court the mother of Baby N, who survived, said she always knew her son had been deliberately harmed.She said she felt “happy and relieved” when the police got in contact to say they were investigating Letby because “we felt like we were being listened to”.”Finally we would receive some answers,” she said.She said: “We just questioned why a healthy baby boy was fine one minute and bleeding from the mouth and needing CPR the next.”Image source, CPSIn a video statement, the mother of triplet brothers Baby O and P said going through “firsts” with the surviving triplet was “very hard”.”I hate the fact that Lucy Letby was the last person to hold Baby P,” she said, adding she had “destroyed our lives”.Their father said he felt like he had been “stabbed in the heart, no words could describe how I was feeling”.”We have tried to explain to our children that there’s a lady in prison and that the police think that this lady has hurt your brothers,” he said. “We did this in case they hear anything from a third party or at school. “Having to come to terms with a police investigation has been hard to live with.”He said he had “so many unanswered questions” and the waiting had been “unbearable”.Image source, SWNSNicholas Johnson KC, prosecuting, told the court Letby’s offending was a “very, very clear case” for a whole-life tariff to be imposed.He said the murders qualified on a number of grounds, including they were premeditated and they involved an elements of “sadistic conduct”.Mr Johnson said there was also more than one victim and those victims were children.Prime Minister Rishi Sunak also said it was “cowardly” for convicted criminals not to face victims or their families in court.BBC Action LineThis is a distressing case so if you, or someone you know, need help after reading about it, the details of organisations offering assistance can be found on the BBC Action Line website. Why not follow BBC North West on Facebook, Twitter and Instagram? You can also send story ideas to northwest.newsonline@bbc.co.ukMore on this story’Like a horror story’: Families speak as Lucy Letby refuses to face courtPublished3 hours agoPM: Cowardly not to face victims’ families in courtPublished1 hour agoNurse Lucy Letby to be sentenced for baby murdersPublished4 hours agoHow could the NHS stop a future killer within?Published6 hours agoJudge should lead Letby inquiry – committee chairPublished19 hours agoFamilies call for greater powers in Letby inquiryPublished1 day agoGovernment orders inquiry into Lucy Letby murdersPublished2 days agoNurse Lucy Letby guilty of murdering seven babiesPublished2 days agoWho is baby serial killer Lucy Letby?Published2 days agoThe text messages Letby sent as she killed babiesPublished2 days agoTwins’ parents: ‘Letby took everything from us’Published2 days agoWarnings ignored as Letby killed more babiesPublished2 days agoWatch: Lucy Letby’s first police interviewPublished2 days agoWatch moment police arrest Lucy Letby. Video, 00:00:43Watch moment police arrest Lucy LetbyPublished2 days ago0:43Lucy Letby jury can return majority verdictsPublished8 AugustJury considers verdicts in Lucy Letby murder trialPublished10 JulyWhat did Lucy Letby do to babies in her care?Published2 days agoRelated Internet LinksHM Courts ServiceThe BBC is not responsible for the content of external sites.